Alveolar Bone Fracture

Baby Teeth and Dental Trauma

In this section, we will cover:

  1. What is an alveolar bone fracture?
  2. What should I do after the injury?
  3. Will I need treatment?
  4. What can I do to help the area heal at home?
  5. Will I need any follow up appointments?
  6. What should I look out for?
  7. What are the long term complications?

What is an alveolar bone fracture?

This is an injury which results in fracture of the bone which holds the teeth in place. This bone is known as the "alveolar bone". You will usually find:

  • mobility of broken segment of bone with multiple teeth moving together 
  • interference when trying to bite together

What should I do after the injury?

It can be very distressing if your child has suffered trauma to the teeth. The first thing to do is not panic.

Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.

You should:

  1. Take a second to collect yourself and check your child hasn't blacked out.
    If your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury).

  2. Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.

  3. If there is any bleeding, you should dampen a clean handkerchief in salt water and press it firmly on the bleeding area.

  4. If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.

Will I need treatment?

Your dentist will take an xray as a "baseline" against which they can compare future xrays. They may need to take more than one xray to see where the fracture line runs along the bone.

The injured area will likely be loose, displaced and causing an interference with the bite. The procedure needed to treat this injury can be quite involved and time-consuming. The steps involved are:

  1. Giving local anaesthetic to numb the injured area. Your dentist will place a numbing cream on the gum first to make this as comfortable as possible for your child. It is useful during this part of the treatment to use distraction techniques such as wiggling the toes or telling a story. You may need to gently hold your child's hands/arms to prevent them from pulling away the local anaesthetic as this could be unafe.
  2. Repositioning the displaced segment back to its original position, or as close to it as possible
  3. Placing a splint (flexible metal wire) on the teeth to keep the loose segment in place for 4 weeks 

It can be difficult for young children to sit through this procedure so treatment is often best provided by a dentist/team which is specialised in managing dental trauma in children. 

If there are any injuries to the soft tissue, you can see here for more information.

What can I do to help the area heal at home?

To help the area heal at home, you should:

  • Brush the teeth after every meal with a soft toothbrush
  • Gently brush the injured area to prevent build up of plaque
  • Use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day for 1 week
  • Have a soft diet for the first few days
  • Take medicine to help manage any discomfort (ibuprofen or paracetamol)
  • Avoid contact sports

Will I need any follow up appointments?

Your dentist will want to review your child for clinical examination after:

  • 1 week
  • 4 weeks (to remove the splint and take an xray)
  • 8 weeks
  • 1 year (to take an xray)
  • at 6 years old to monitor the eruption of the adult tooth 

What should I look out for?

The long term consequences of dental trauma are unpredictable. You should monitor your child's teeth for any signs of infection.

    Favourable outcome

    Baby tooth:

  • No pain
  • Normal colour of the tooth
  • Temporary darkening of the tooth to red/grey/yellow
  • Loose/displaced segment repositioned without any disturbance in the bite 



Adult tooth:

  • Erupts at normal time
  • No defects in enamel (outer layer of tooth)

Unfavourable outcome

Baby tooth:

  • Pain
  • Abscess on the gum
  • Increased mobility (but this can be normal as the adult tooth starts to come through)
  • Permanent grey/brown discolouration of the tooth, along with one of the signs/symptoms above
  • Loose/displaced segment not in correct position or still interfering with the bite 

Adult tooth:

  • Doesn't erupt at expected time (usually 6-7 years old)
  • Discoloured or thin enamel layer
Dental abscess
Dental abscess

What are the long term complications?

If the any of the baby teeth become painful or infected, they will need to be removed (see dental extraction). There will be a gap here until the adult tooth erupts at around 6-7 years old.

Treatment can be done under local anaesthetic, inhalation sedation or general anaesthetic depending on the age and cooperation of your child.

Complications with the underlying adult tooth are quite rare but can be seen in alveolar bone fractures:

  1. Adult tooth doesn't erupt
  2. Discoloured patches on enamel (hypomineralisation - find out more here LINK)
  3. Thin enamel (hypoplasia - find out more here LINK)

Adult tooth doesn't erupt

If the adult tooth hasn't erupted by 7 or 8 years old, your dentist will take a series of xrays to check where the tooth is and what the root looks like.

Depending on what the xrays show, your child may need one of the following surgical procedures:

  • Expose and bond. (LINK)
    Sometimes the tooth can be brought into the mouth through the gum. This involves a surgical procedure to uncover the tooth and braces to pull the tooth in line with the rest of the teeth.
  • Dental extraction.
    If it is not possible to bring the tooth in line with the rest of the teeth, the tooth can be removed (see here).
  • Monitor the tooth without treatment.
    The tooth can be left under the gum but it will need to be monitored with xrays to ensure it doesn't cause problems over time.

Discoloured patches

A knock to the baby tooth can disturb the development of the underlying adult tooth. This disrupts the formation of healthy enamel and causes discolouration.

Treatment options:

Thin enamel

A knock to the baby tooth can disturb the development of the underlying adult tooth resulting in only a thin layer of enamel being formed. 

Treatment options:

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